Are apples causing your stomach problems?

March 20, 2017

Jennifer Graham

Deseret News

An apple a day can cause gastric distress if you're one of the estimated 10 percent of Americans who suffer from irritable bowel syndrome, commonly known as IBS. That's why apples are losing their shine among people who embrace an increasingly popular way of eating — called the low FODMAP diet — to improve their digestion and health.

It's a marked departure from a food long considered a nutritional powerhouse, despite its reputation as the "forbidden fruit" in the biblical Garden of Eden.

Mothers have told their children "An apple a day keeps the doctor away" for more than a century, and more recently, Spartan Fit! founder Joe De Sena famously prescribed an all-apple diet for 10 days for a man who who showed up at his complex seeking better health. Others opt for a two- or three-day apple diet to jumpstart their health.

But the oddly named low FODMAP diet that is getting attention these days is calling some people to rethink apple consumption. Should the apple be a forbidden fruit today? The answer may be yes if you suffer from a range of gastric problems that include irritable bowel syndrome and fructose malabsorption. For everyone else in your family, the fruit still contains a wealth of nutrients and is generally an inexpensive, low-calorie food.

Low FODMAP and IBS

Irritable bowel syndrome is commonly diagnosed for chronic digestive problems that include cramping, abdominal pain, bloating, gas, diarrhea and constipation. The condition is thought to affect more than one in 10 people, more than 60 percent of them women.

The low FODMAP diet that is designed to treat IBS was created by researchers at Monash University in Melbourne, Australia. The diet draws its clunky name from an acronym describing types of carbohydrates that can contribute to gastric distress among IBS sufferers. They are fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

More simply put, they represent a range of fruits, vegetables, grains, dairy foods and sweeteners that some people have trouble digesting. When such a person eats a high FODMAP food — like, say, an apple or onion — the undigested food attracts extra fluid into the digestive tract, causing bloating. And bacteria in the large intestine feed on the undigested food, causing fermentation and gas. (Here's an animated video from Monash University that shows how this happens.)

Because people differ in how their bodies handle different types of foods, the Monash researchers believe that the best way to deal with IBS is for sufferers to test their own tolerance, becoming what the late physician George Sheehan called "an experiment of one."

People trying the diet eliminate a large group of high-FODMAP foods for about six weeks and then gradually re-introduce them to their diet, one at a time, while monitoring their response. The ones that cause problems again are the ones to avoid in the future.

The foods to avoid include onions, celery, garlic, asparagus, legumes and pulses among vegetables; apples, pears, watermelon, peaches and plums among fruits; milk, yogurt, ice cream and soft cheese among dairy; wheat-based bread, pasta and cereal; and cashews and pistachios.

It's a daunting regimen that so far has only a modest number of small studies to recommend it. The largest, USA Today reported, is a study of 92 people undertaken at the University of Michigan. It found that 52 percent of participants following a low FODMAP diet experienced relief from IBS symptoms.

"The data are not overwhelming. But I think it’s a reasonable thing to try," Brian Lacy, chief of gastroenterology at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, told Kim Painter for USA Today.

What's wrong with apples?

Apples make the FODMAP list because, according to the Cleveland Clinic, they're particularly high in fructose, which, along with lactose, tends to be problematic for IBS sufferers.

In an essay for the U.K. newspaper The Daily Mail, British journalist Ross Clark described how eliminating apples and other fruit vastly improved his sense of health and well-being. He believes his body does a poor job of absorbing fructose, a condition that has been linked not only to bloating and other gastric woes, but also to low moods. (Fruit sugar seems to interfere with serotonin levels, Dr. Emily Deans confirmed in Psychology Today.)

Livestrong, however, blames apples' high fiber content for their role in digestive problems, and some people find they're able to tolerate apples if they don't eat the peel, which is high in fiber. Others find a derivative of apples — apple cider vinegar — taken daily offers relief of stomach discomfort.

For people who don't suffer from gastric disorders, apples remain one of nature's healthiest foods. Prevention magazine calls them "an icon of health," and the late American mystic Edgar Cayce advocated a three-day apple diet several times a year, not for weight loss, but to restore vitality.

The U.S. Apple Association touts the apple's nutritional benefits, which include antioxidants and fiber, and notes that as far back as the time of Galen and Hippocrates, sour apples were used as medicine. But it's the "apple a day" saying that is most responsible for the apple's wholesome reputation, and that can only be traced back about a century or so, according to an article by Margaret Ely in The Washington Post.

Before then, the proverb was a bit more stilted: "Eat an apple on going to bed, and you’ll keep the doctor from earning his bread.”

Despite its current unpopularity among some sufferers of irritable bowel syndrome, the apple has weathered far worse press, going back to the Garden of Eden.

The Old Testament book of Genesis does not identify the fruit that Eve disobediently plucked from the tree, but by the Renaissance, artists were depicting it as an apple, possibly because the Latin word for "apple" and "evil" — malus — is the same, according to National Geographic. It may have actually been a fig, an apricot or a grape, some people have speculated.

But the case of mistaken identity has not affected apples' popularity among families. According to a 2015 study published in the journal Pediatrics, apples are the most popular fruit among children ages 6 to 11, accounting for 22.4 percent of fruit consumed.